Asian Solidarity Collective Membership Form

This is a membership application form. You will be contacted by a Core Member of Asian Solidarity Collective once your form for membership has been reviewed.
Email address *
Full Name - Last Name, First Name *
Preferred Name (Nick Name)
Pronoun (Ex: She/Her, He/Him, They/Them, etc) *
Birth date *
MM
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DD
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YYYY
What is your race? (Please check all that apply. Our goal is to have a membership that is diverse BIPOC - Black, Indigenous, People of Color communities) *
Required
If Asian American, what is your ethnicity? (Our goal is to have a membership that is multi-racial and multi-ethnic. If not Asian American, please write N/A.) *
Address *
Phone number *
Email *
Emergency Contact *
Family/Extended Family (up to 4 family members may be included in your membership) For each member please include their full names , pronouns, birthdate and contact # (if their number is different from your own).
Type of Membership (Sometimes this will change within the year depending on your capacity, and that's more than okay) *
Would you be able to donate a minimum of $20.00 (per family) or more per year as part of ASC’s annual membership dues? *
If no, would you be open to a sliding scale donation?
Clear selection
If yes, how much? Please donate here: http://bit.ly/supportASC
Asian Solidarity Collective is a grassroots primarily volunteer and member-driven organization. We work with our members and community volunteers to organize events and to take lead in our campaigns in order to build power and activate critical consciousness within our communities and beyond. Would you like our staff to contact you regarding volunteering opportunities? *
If yes, what skills would you like to contribute?
What areas of volunteership are you interested in with Asian Solidarity Collective? Check all that apply.
Organizations you are already affiliated with
Please share why you are interested in being an Asian Solidarity Collective member: *
If you agree with the Statement of Understanding Asian Solidarity Collective’s work and values, please state your full name and date below: I understand Asian Solidarity Collective’s (ASC) Mission, Vision, Ideology, and Principles of Unity. I understand ASC’s work in activating social justice consciousness within our own communities as well as building solidarity towards collective liberation. I recognize the importance of having core values that align with Asian Solidarity Collective and the communities whom we serve in order to become an ASC member. I acknowledge that Asian Solidarity Collective reserves the right to work, partner and engage in membership with individuals and/or community organizations who have shared visions and values for justice. I fully understand that Asian Solidarity Collective will review this application and will notify me in regards to membership with the organization. *
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This form was created inside of Asian Solidarity Collective.